Provider Demographics
NPI:1609917905
Name:BANKHEAD, BRENT DEE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DEE
Last Name:BANKHEAD
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:12101 SUTTON PLACE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2180
Mailing Address - Country:US
Mailing Address - Phone:314-843-0439
Mailing Address - Fax:636-978-0240
Practice Address - Street 1:2990 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7861
Practice Address - Country:US
Practice Address - Phone:636-978-4484
Practice Address - Fax:636-978-0240
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO0158761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics